The nurses union was preparing for another strike. They stood outside Saint Barnabas Medical Center, their anger brimming over, and they were getting personal — to the tune of a Broadway musical.

“Del Mauro, Del Mauro,” they sarcastically sang, substituting a name in place of “Tomorrow” from the musical “Annie.”

It was 1984 and just the beginning of another round of contract negotiations. But Ron
Del Mauro, at the time the 40-year-old head of the personnel department at Saint Barnabas, had already become the focus of their ire, because he was holding the hospital’s line in the acrimonious talks with the new union. The last two negotiations had resulted in strikes that essentially shut down the hospital, and the nearly-bankrupt Saint Barnabas couldn’t afford another one.

Looking back, people at the table say it was Del Mauro’s guiding hand that brought a compromise on salary and benefits to avert the strike and keep the hospital going.

“Strikes are tough,” Del Mauro, 67, says now. “I could be tough. But I felt I had an obligation to protect the institution, the employees and its future. There can be no compromise when it comes to that. I never wanted anyone to read between the lines.”

At that point, more than a quarter century ago, it wasn’t only the nurses union taking note of the young executive. Shortly after the difficult negotiations, the board of trustees would vote Del Mauro in as the chief executive officer. In the years after that, people around the state would take notice of him, as Del Mauro steered a single hospital from the brink of oblivion and recast it as the state’s largest health system, which at one time included 10 acute-care facilities.

Until his retirement last week, Del Mauro was considered by many in the health care industry as one of the most influential businessmen in the state — as a firm but fair leader, by most accounts.

But it hasn’t always been easy, and the hospital went through dire straits again a few years ago after a Department of Justice investigation for Medicare fraud and a subsequent $265 million settlement with the federal government. Still, Del Mauro is leaving a stable Barnabas Health that still provides services to 2 million patients each year and is the second-largest private employer in New Jersey.

Experts say that wouldn’t have happened if Del Mauro hadn’t been at the helm.

“Ron Del Mauro is a true icon in New Jersey health care and beyond,” says Betsy Ryan, the president of the New Jersey Hospital Association. “He has been a visionary leader, who assembled the state’s largest integrated health care system, long before the concepts of integration, consolidation and better coordination of care became the foundation of the federal health care reform law.”

Del Mauro grew up in Newark’s North Ward, raised by his parents Helen and James Del Mauro, who was a well-known judge. He graduated from Seton Hall University and was looking for a job when he happened upon an open slot at Saint Barnabas in 1967. The hospital had recently moved from Newark to Livingston, and it was still attempting to gain its footing in suburbia. Del Mauro began in personnel.

By the 1980s, he had worked his way to the top of the department and was making a name for himself through the union negotiations.

From pictures over the years, Del Mauro hasn’t aged much, apart from a little less hair.

He is engaging in person, plainspoken, with a deep, raspy voice. He is also an intent listener, his eyebrows always arched, like he’s perpetually surprised — but nothing in a conversation escapes his notice. Barnabas employees say he gives everyone the same focus — from secretaries to heart surgeons to janitors.

“I used to sit in the cafeteria wondering what the buffoons in administration were doing.
Then, I was one of those buffoons — and I didn’t know what was going on the cafeteria,” he says. “You always have to get back to the individual employee. You can’t get lost in the numbers.”

During Del Mauro’s tenure, the hospital in the mid-1990s started an unprecedented expansion, acquiring Newark Beth Israel and Clara Maass in Belleville, among others, and struck south, to Monmouth and Ocean counties, acquiring Community Medical Center in Toms River and Kimball Medical Center in Lakewood.

John O'Boyle/The Star-LedgerRonald Del Mauro

Not everyone interviewed for this story admired Del Mauro’s admittedly tough leadership or was supportive of Saint Barnabas’ expansion. A few people interviewed about Del Mauro’s retirement said his leadership often went unquestioned — because he would not tolerate challenges to his authority. Those people asked to remain anonymous, saying they feared reprisals from the system.

But some say they valued Del Mauro’s resolve.

“Ron just didn’t take no for an answer,” says David Knowlton, the president and CEO of the New Jersey Health Care Quality Institute, and former acting commissioner of the state Department of Health and Human Services. “He had vision, he knew what was right, and he just went around you, if he had to.”

Gary Carter, the former president of the New Jersey Hospital Association, says he admired Del Mauro for being firm, but fair, in all his dealings.

“You don’t get to the top without being firm and sticking to what you believe in,” Carter says. “But he would always listen to other sides of the argument, even if he didn’t always agree.

“He saw the future and aggressively went after it,” Carter adds. “But he didn’t shy away from adapting when mistakes were made.”

There were, indeed, serious challenges in recent years. As recently as 2008, the hospital system was on the “brink of oblivion,” Del Mauro admits.

In recent years, four of the 10 hospitals in the system have closed, and there have been additional financial pressures. Saint Barnabas’ billing on some Medicare patients was investigated by the U.S. Department of Justice in 2003, and the federal government originally alleged the health system had bilked the government of $500 million or more over the few years previous. There were no criminal charges, but the hospital agreed in 2006 to repay $265 million to Medicare — payments that are ongoing.

The “issue was devastating to the system. … Everything we tried to build was built on our reputation,” says Del Mauro. “The timing and aggressiveness (of the Department of Justice investigation) surprised me the most.”

In 2009, the hospital system turned a profit for the first time in several years, according to Ellen Greene, a spokeswoman for Barnabas Health.

Del Mauro is not only well-known and respected for his years with the hospital. He was also well-paid for his successes.

Greene confirmed Del Mauro made $7.9 million in 2006 in total compensation, including deferred compensation and non-taxable benefits. In 2009, he earned $2 million in total compensation, according to federal tax forms, but Greene would not comment further on more recent years or retirement package specifics.

Del Mauro, who was saluted last month in an event at the New Jersey Performing Arts Center attended by 1,700 people, says he has no definite retirement plans yet, but is considering consulting for a couple of Wall Street firms and serving on a couple nonprofit boards. He says he will be keeping busy.

“I’ll probably have a pretty full plate,” he says. “I don’t know how to define ‘retirement.’ ”